Archive for category Traumatic Stress Disorder
High levels of estrogen may help protect a woman from mood disorders, while low levels of the hormone can make a woman more susceptible to trauma at certain times in her menstrual cycle, according to new research by Harvard and Emory University neuroscientists.
Depression and anxiety disorders are twice as common in women as in men, but the reason for this gender difference has remained unclear. The new research, however, suggests that women are most at risk for symptoms of post-traumatic stress disorder (PTSD) when their estrogen is low during the menstrual cycle.
“PTSD is a disorder of recovery,” said author Mohammed Milad, associate professor of psychiatry at Harvard Medical School (HMS) and director of the Behavioral Neuroscience Laboratory at Massachusetts General Hospital (MGH).
Men may be less susceptible to mood disorders since testosterone is regularly converted into estrogen in the male brain, resulting in a more steady flow of estrogen.
In healthy women and female rats, estrogen calms the fear response, according to the Harvard researchers, who were led by Kelimer Lebron-Milad, an HMS instructor of psychiatry.
The Emory researchers, led by postdoctoral researcher Ebony Glover, proved that the same is true for women suffering from PTSD. The higher their blood levels of estrogen were when they completed a fear-extinction task, the less likely women were to act startled.
Both studies used “fear-conditioning” experiments, in which the participant is trained to fear a safe “conditioned stimulus” such as a colored shape, paired with a frightening or painful “unconditioned stimulus” like a shock to the finger or a puff of air to the neck or eye.
Overall, women or female rats showed less fear to the neutral stimulus when their estrogen levels were high rather than low.
PTSD is common in women after a trauma such as rape or sexual assault, which studies say are experienced by 25 to 30 percent of women in their lifetimes, and the symptoms last on average four times as long in women as in men after trauma.
This new research suggests the reason for this vulnerability may be the monthly menstrual change in estrogen.
“People are afraid to look into the influence of sex hormones on ‘fear learning’ and extinction,” said Mohammed Milad, “because it’s such a complex system.”
When Milad studied fear as a Ph.D. student, his lab used only male rats. But when he began to study fear in humans as a postdoctoral researcher, he saw that female data were much more variable.
“The data led me there,” to sex differences, Milad said. “Since females add variance, scientists have tended to avoid studying them” in rodent research, he said. Studies of the human brain would tend to combine men and women, assuming that neurological gender differences were minimal. But this attitude is changing.
In addition, since birth control pills affect estrogen levels, they may be used as a future treatment against post-traumatic stress.
The research is published in Biological Psychiatry.
Source: Biological Psychiatry
Current and former soldiers who seek treatment for post-traumatic stress disorder (PTSD) should be screened closely for major depression since the disorder is the single strongest driver of suicidal thinking, say authors of a new Canadian study.
Researchers evaluated 250 active duty Canadian Forces, RCMP members and veterans. The study comes at a time when record numbers of suicides are being reported among American troops returning from Afghanistan and Iraq, and the number of suicides reported among Canadian forces last year reached its highest point since 1995.
In veterans suffering from post-traumatic stress disorder, about half also have symptoms of major depressive disorder during their lifetime, said the researchers.
But “the task of predicting which people may be at an increased risk of completing suicide is a complex and challenging care issue,” they said.
The study included 193 Canadian Forces vets, 55 active troops and two RCMP members referred to the Parkwood Hospital Operational Stress Injury Clinic in London, Ontario.
Soldiers and vets were screened for PTSD, major depression, anxiety disorders and alcohol abuse. The depression questionnaire also included questions about suicidal thinking.
Study participants served an average of 15 years and had been deployed an average of three times. About one-fourth had been deployed to Afghanistan at least once. Ninety-two per cent were men.
Most met the criteria for “probable” PTSD, and almost three-fourths screened positive for probable major depression.
Overall, about one-fourth — 23 percent — said that they had experienced thoughts of self-harm, or that they would be better off dead, for several days over the prior two weeks.
Another 17 percent said they had those thoughts more than half of the days in the past two weeks; six percent reported feeling this way almost every day for the previous two weeks.
As found in other studies, the researchers showed that PTSD is linked to suicidal thoughts. But “what became the biggest predictor was, specifically, depression severity,” said Dr. Don Richardson, a consultant psychiatrist at the Operational Stress Injury Clinic and an adjunct professor in the department of psychiatry at Western University in London.
“It really stresses the importance that when you’re assessing someone for PTSD it’s also critical that you assess specifically for major depression,” Richardson said. “From our limited study, it was depression severity that was the most significant predictor of having suicidal ideation.”
The concern is that soldiers seeking treatment for military-related trauma might not receive aggressive therapy for depression. Instead, the focus might be more focused on PTSD and exposure therapy.
“There’s potentially a lot of people out there who are suffering who might not be aware that there are effective treatments, and that there are clinics available across Canada that specialize in military trauma,” said Richardson.
Natural childbirth is a major cause of post-traumatic stress disorder (PTSD), according to new research.
A Tel Aviv University researcher has discovered that approximately one-third of all postpartum women exhibit some symptoms of PTSD, and a smaller percentage develop full-blown PTSD following labor.
Of the women who developed symptoms, 80 percent opted for natural childbirth without pain relief, reported Professor Rael Strous of TAU’s Sackler Faculty of Medicine.
Other significant factors identified in the study include the woman’s body image, including discomfort about being in an undressed state for a relatively prolonged period of labor and undergoing elective Caesarean sections; fear during labor; and complications in not only this pregnancy, but in earlier ones as well.
Researchers interviewed 89 post-partum women between the ages of 20 and 40, first within five days after delivery and then again one month after delivery.
They discovered that of these women, 25.9 percent displayed symptoms of PTSD, 7.8 percent suffered from partial PTSD, and 3.4 percent exhibited symptoms of full-blown PTSD.
Symptoms included flashbacks of the labor, the avoidance of discussion of the event, physical reactions, such as heart palpitations during such discussions, and a reluctance to consider having another child.
According to Strous, one of the most influential factors was pain management during delivery. Of the women who experienced PTSD symptoms, 80 percent had gone through a natural childbirth, without any form of pain relief.
“The less pain relief there was, the higher the woman’s chances of developing post-partum PTSD,” he said. Of the women who did not develop any PTSD symptoms, only 48 percent experienced a natural childbirth, he added.
A full 80 percent of the PTSD group reported feeling discomfort with being unclothed, and 67 percent had previous pregnancies which they described as traumatic. Fear of the labor itself, both in terms of expected pain levels and danger to themselves and their children, was also influential.
The researchers also discovered that support during labor, in the form of a midwife or doula, had no impact when it came to avoiding PTSD symptoms. Other factors, such as socioeconomic and marital status, level of education, and religion, also had no effect.
Strous suggests doctors become familiar with the profile of women more disposed to suffer from PTSD symptoms, and be on the look-out for warning signs after labor. He also advocates additional research to develop better treatment plans and make more resources available for women.
There are some immediate steps medical professionals can take, Strous added, including better counseling about pain relief and making sure that patients’ bodies are properly covered during delivery.
“Dignity is a factor that should be taken into account,” he said. “It’s an issue of ethics and professionalism, and now we can see that it does have physical and psychological ramifications.”
The study was published in the Israel Medical Association Journal.